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腹腔镜下治疗十二指肠重复畸形1例报道

交界可切除胰头癌新辅助化疗后行联合静脉切除重建 LPD 的初步体会

目的探讨交界可切除胰头癌新辅助化疗后行联合静脉切除重建的腹腔镜胰十二指肠切除术（laparoscopic pancreaticoduodenectomy，LPD）的安全性及可行性。方法回顾性收集并分析 2019 年 8 月至 2021 年 1 月期间于四川大学华西医院上锦分院肝胆胰微创外科实施的 4 例交界可切除胰头癌新辅助化疗后行联合血管切除重建的 LPD 患者的临床资料。结果4 例患者均在完全腹腔镜下完成手术，手术时间分别为 520、452、375 和 430 min，术中出血量分别为 300、800、150 和 200 mL，术后住院时间分别为 36、20、16 和 16 d。术后 1 例患者出现胆汁漏、行再次引流后好转出院，1 例出现乳糜漏，导致引流管拔除时间及住院时间延长，其余 2 例未出现并发症，正常出院。4 例患者术后病理学检查证实均为胰头导管腺癌，总生存期分别为 18、12、20 和 11 个月（仍存活）。结论对于高度选择性的交界可切除胰头癌新辅助化疗后行联合静脉切除重建的 LPD 在经验丰富的大的胰腺中心是安全可行的，但仍需大样本随机对照试验来验证这一结论。

Totally Laparoscopic Associating Liver Tourniquet and Portal Ligation for Staged Hepatectomy Using The Anterior Approach Techniquefor Hepatocellular Carcinoma with Hepatitis B Cirrhosis

ObjectiveTo investigate the application value of totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) using the anterior approach technique for hepatocellular carcinoma (HCC) with hepatitis B cirrhosis. MethodsIn September, 2014, a patient suffered cirrhotic hepatocellular carcinoma in the right liver scheduled for two-stage liver resection, in whom the future liver remnant (FLR) was considered too small (FLR/standard liver volume:29.1%, FLR/body wight:0.49%). In the first stage, using totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie's line via an anterior approach through retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. In the second stage, totally laparoscopic right hemihepatectomy was carried out on 10 days after the first-stage operation that achieved sufficient hypertrophy of the FLR. ResultsThe FLR on postoperative day 4 of the first stage increased from 301.48 to 496.45 mL (FLR/standard liver volume:47.9%, FLR/body wight:0.81%), with a 64.67% hypertrophy. And the FLR on postoperative day 8 of the first stage increased to 510.96 mL (FLR/standard liver volume:49.3%, FLR/body wight:0.84%), with a 69.48% hypertrophy. The remnant liver volume on postoperative day 5 of the second stage increased to 704.53 mL. The duration of the first stage was 180 min, intraoperative blood loss was 50 mL, and patient did not received a blood transfusion. The duration of the second stage was 220 min, intraoperative blood loss was 400 mL, and patient did not required a blood transfusion. No serious complications happened. The patient was discharged on 7 days after the second stage. ConclusionsAs a effective, safe, simple, and "non-touch" technique which provided a less aggressive modification of the ALPPS procedureto achieve oncological efficacy, the totally laparoscopic ALTPS using the anterior approach technique also could achieve sufficient hypertrophy of the FLR in several days. A proper expansion of the indications for the procedure is safe and feasible in HCC patients with cirrhosis.